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Normal brain circuits may cause movement disorder

   
Specific changes in brain pathways may counteract genetic mutations for the 
movement disorder dystonia, according to new research in the Journal of 
Neuroscience. Few people who inherit dystonia genes display symptoms — namely 
sustained muscle contractions and involuntary gestures — and the study 
provides a possible explanation. This result could lead to new treatments for 
the estimated 500,000 North Americans diagnosed with dystonia. 
In this study, researchers looked at how brain connections might explain the 
disorder. "Our findings begin to show why someone can live with a genetic 
mutation without ever developing the disease," said David Eidelberg, MD, at 
The Feinstein Institute for Medical Research, the study's senior author. 
Scientists at The Feinstein Institute used an MRI-based approach called 
diffusion tensor imaging, a technique that maps the connections between 
structures in the human brain. Twenty patients with mutated genes associated 
with dystonia were assessed (12 with symptoms, eight without), along with 
eight healthy patients without these mutations. 
The authors identified two different brain pathways that determine the 
severity of symptoms. One pathway connecting the cerebellum with the thalamus 
is abnormal in all people carrying the mutant gene, and predisposes carriers 
to dystonia. In the patients with mutated genes but no symptoms, a second 
pathway between the thalamus and the cortex is also abnormal. Surprisingly, 
this second pathway is normal in patients with symptoms. The researchers 
suggest that in people who have the mutations but no symptoms, the second 
abnormality may offset the effect of the first, preventing the disease's 
outward signs.
David Standaert, MD, PhD, at University of Alabama at Birmingham, is an expert 
in Parkinson's disease and other movement disorders and was not affiliated 
with the study. Standaert says that although dystonia is a relatively rare 
disorder, the study has implications for other neurological illnesses, such 
as Parkinson's, Alzheimer's, and Huntington's diseases; ataxia and muscular 
dystrophies; and even forms of migraine.
"The core idea here is that many diseases can be triggered by a single gene, 
but the expression of this gene can differ greatly, even in individuals from 
the same family," Standaert said. "Dystonia provides dramatic examples of 
this. Two siblings may have the same abnormal gene, but one will be severely 
disabled by twisting and cramping of the muscles, while the other will be 
essentially normal." 
The pathway abnormalities identified in the study could likely have formed in 
an early stage of brain development, Standaert suggested. Symptoms in adult 
life, therefore, may be determined by subtle shifts in early brain growth. 
Detailed study of these newly implicated pathways in both humans and animals 
could lead to ways to prevent symptoms, if balance to the affected pathways 
is restored.
Source: Society for Neuroscience

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